PBS高端访谈:美国应尽早投资于健康事业

 　　JUDY WOODRUFF:Much of the national focus on improving health care has centered on the expansion of coverage¹ that's starting to take effect. But a report out today says it's time for the country to pay more attention to the socioeconomic conditions that play a role in health outcomes, especially for lower-income Americans.

　　The recommendations, issued by a nonpartisan commission created by the Robert Wood Johnson Foundation, call for new investments like pre-k education for children under 5.

　　David Williams is a professor at Harvard's School of Public Health. He was a staff director for the commission as well.

　　And, for the record, the foundation is one of our sponsors for health coverage.

　　Professor Williams, it's good to have you with us.

　　DAVID WILLIAMS,Harvard School of Public Health: It's good to be with you.

　　JUDY WOODRUFF:So what is the rationale for thinking that doing something about socioeconomic conditions is going to be connected to a health improvement?

　　DAVID WILLIAMS: Well, first, the larger context is, as a nation, we have a huge problem. We spend more money on medical care than any other country in the world.

　　According to the World Bank, half of the money spent on medical care in the world annually² is spent in the United States. Yet we rank among -- at the bottom of the industrialized world on health and we are losing ground over time. So we have a crisis. And the problem is not just a problem of the low-income individuals and the poor.

　　Even the best-off Americans are not currently achieving a level of health that is possible. And more medical care spending will not solve it. We now need to look at what are the drivers of health in the first place.

　　Our health care system is wonderful. We have great facilities. We have the best-trained medical work force in the world, but to a large degree, medical care is a repair shop that takes care of us once we get sick, and it doesn't determine whether we get sick or not in the first place.

　　JUDY WOODRUFF:So, what is an example of something that can be done to improve someone's what we call socioeconomic status, whether it's education or something else, that then leads to an improvement in health?

　　DAVID WILLIAMS: So, let's talk about early childhood development.

　　What we know is that the foundations of health in adulthood³ are laid in childhood. And the opportunities and the experiences that children have even before they go to school shape their risk of chronic⁴ disease 30, 40 years later, so that everything that we can do to prepare those children and give them the optimal⁵ health and optimal developmental opportunities in the preschool area, then they're ready for school, and they have high levels of education, and they will have better health for the rest of their life.

　　JUDY WOODRUFF:But can you give us an example of something they would learn in school that would then lead to a better health outcome?

　　DAVID WILLIAMS:Certainly, more health education and more physical fitness in school are good, but that is not where I'm going.

　　We're going on preparing those kids for learning. So, for example, a child exposed to toxic⁶ stress -- and toxic stress are examples of being taken care of by a caregiver who is chronically⁷ depressed⁸, growing up in chronic poverty, being a victim of abuse -- that child will have more problems in success in school, but will also have more health problems as an adult.

　　Studies show that we can actually measure the alteration⁹ of brain structure in those preschool kids linked to their exposure to toxic stress.

　　JUDY WOODRUFF:At the same time, I was reading today that, of course, there is disagreement among experts about whether universal pre-K education, which is one the things I think your task force is calling for, is good for all children.

　　How do you look at the arguments that are out there about this?

　　DAVID WILLIAMS:I think every child needs the opportunity for healthy development.

　　For many children, they may get that in the home. And they don't have to go to a preschool setting. So we are not necessarily calling for preschool -- universal preschool for all. We are calling for universal preschool for those who are in environments where they need that healthy environment to do well.

　　And that certainly characterizes many of our lower socioeconomic populations.

　　JUDY WOODRUFF:Looking at -- looking again at some of your recommendations, it's a pretty ambitious agenda. How do you pay for it?

　　DAVID WILLIAMS:That is a really good question.

　　Given our expenditure¹⁰ on medical care, this money is not -- there isn't a shortage of money in this country. The question is, how do we spend our money and what are our priorities? But the good news is, there are promising¹¹ models all across the country right now with creative public-private participations, like in the state of Minnesota, where the business community and the state has come together to provide scholarships so that all poor kids can get a preschool education.

　　Or there's an example from Texas where the state raised the sales tax by one-eighth of a penny, and that money is allocated¹² for preschool education. So there are wonderful examples.

　　JUDY WOODRUFF:So, you are saying the evidence is already out there that this works?

　　DAVID WILLIAMS:Let me tell you how powerful the evidence is.

　　The best evidence comes from a study done in Ypsilanti, Michigan, more than 50 years ago, the Perry Preschool study, where kids were randomly¹³, by the flip¹⁴ of a coin, received preschool or didn't receive preschool. They have now been followed for 40 years. Those kids that got the preschool, 40 years later, higher levels of education, higher levels of income, higher levels of home ownership, higher levels of marriage, less involvement with the criminal justice system, less involvement with the social welfare system.

　　And for every dollar invested, there is a $17 return to society from that preschool program. That is stunning¹⁵. That is amazing economic development that we can achieve.

　　JUDY WOODRUFF:So, just very quickly, finally, is this something you have to persuade the White House and the Congress to go along with to make it happen?

　　DAVID WILLIAMS:I think there is a lot of interest in pre-K education across the political spectrum¹⁶ in the United States now, because the evidence is so strong that there is such enormous benefit for our society.

　　JUDY WOODRUFF:All right, Professor David Williams of Harvard, we thank you very much.

　　DAVID WILLIAMS: Thank you.

1 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

2 annually   

adv.一年一次，每年

参考例句：

• Many migratory birds visit this lake annually.许多候鸟每年到这个湖上作短期逗留。
• They celebrate their wedding anniversary annually.他们每年庆祝一番结婚纪念日。

3 adulthood   

n.成年，成人期

参考例句：

• Some infantile actions survive into adulthood.某些婴儿期的行为一直保持到成年期。
• Few people nowadays are able to maintain friendships into adulthood.如今很少有人能将友谊维持到成年。

4 chronic   

adj.(疾病)长期未愈的，慢性的；极坏的

参考例句：

• Famine differs from chronic malnutrition.饥荒不同于慢性营养不良。
• Chronic poisoning may lead to death from inanition.慢性中毒也可能由虚弱导致死亡。

5 optimal   

adj.最适宜的；最理想的；最令人满意的

参考例句：

• What is the optimal mix of private and public property rights in natural resources?私人和国家的自然资源产权的最适宜的组合是什么？
• Optimal path planning is a key link for the sailing contest.帆船最优行驶路径规划是帆船比赛取胜的关键环节。

6 toxic   

adj.有毒的，因中毒引起的

参考例句：

• The factory had accidentally released a quantity of toxic waste into the sea.这家工厂意外泄漏大量有毒废物到海中。
• There is a risk that toxic chemicals might be blasted into the atmosphere.爆炸后有毒化学物质可能会进入大气层。

7 chronically   

ad.长期地

参考例句：

• Similarly, any pigment nevus that is chronically irritated should be excised. 同样，凡是经常受慢性刺激的各种色素痣切勿予以切除。
• People chronically exposed to chlorine develop some degree of tolerance. 人长期接触氯气可以产生某种程度的耐受性。

8 depressed   

adj.沮丧的，抑郁的，不景气的，萧条的

参考例句：

• When he was depressed,he felt utterly divorced from reality.他心情沮丧时就感到完全脱离了现实。
• His mother was depressed by the sad news.这个坏消息使他的母亲意志消沉。

9 alteration   

n.变更，改变；蚀变

参考例句：

• The shirt needs alteration.这件衬衣需要改一改。
• He easily perceived there was an alteration in my countenance.他立刻看出我的脸色和往常有些不同。

10 expenditure   

n.(时间、劳力、金钱等)支出；使用，消耗

参考例句：

• The entry of all expenditure is necessary.有必要把一切开支入账。
• The monthly expenditure of our family is four hundred dollars altogether.我们一家的开销每月共计四百元。

11 promising   

adj.有希望的，有前途的

参考例句：

• The results of the experiments are very promising.实验的结果充满了希望。
• We're trying to bring along one or two promising young swimmers.我们正设法培养出一两名有前途的年轻游泳选手。

12 allocated   

adj. 分配的 动词allocate的过去式和过去分词

参考例句：

• The Ford Foundation allocated millions of dollars for cancer research. 福特基金会拨款数百万美元用于癌症研究。
• More funds will now be allocated to charitable organizations. 现在会拨更多的资金给慈善组织。

13 randomly   

adv.随便地，未加计划地

参考例句：

• Within the hot gas chamber, molecules are moving randomly in all directions. 在灼热的气体燃烧室内，分子在各个方向上作无规运动。 来自辞典例句
• Transformed cells are loosely attached, rounded and randomly oriented. 转化细胞则不大贴壁、圆缩并呈杂乱分布。 来自辞典例句

14 flip   

vt.快速翻动；轻抛；轻拍；n.轻抛；adj.轻浮的

参考例句：

• I had a quick flip through the book and it looked very interesting.我很快翻阅了一下那本书，看来似乎很有趣。
• Let's flip a coin to see who pays the bill.咱们来抛硬币决定谁付钱。

15 stunning   

adj.极好的；使人晕倒的

参考例句：

• His plays are distinguished only by their stunning mediocrity.他的戏剧与众不同之处就是平凡得出奇。
• The finished effect was absolutely stunning.完工后的效果非常美。

16 spectrum   

n.谱，光谱，频谱；范围，幅度，系列

参考例句：

• This is a kind of atomic spectrum.这是一种原子光谱。
• We have known much of the constitution of the solar spectrum.关于太阳光谱的构成，我们已了解不少。